May 16, 2020
Why You Should Practice Your Scoliosis Exercises Daily
Why do we sometimes treat Adolescent Idiopathic Scoliosis with conservative therapy options? Treatment outcomes for Adolescent Idiopathic Scoliosis (AIS) is often focused on reduction or stabilisation of the Cobb angle measured on X-Ray. I have seen many patients and their families with a major focus on Cobb angle, and rightfully so. Surgeons talk about Cobb angle. General practitioners talk about Cobb angle. Physiotherapists and orthotists talk about Cobb angle. How can we then expect the focus of successful treatment outcomes to be anything other than a reduction in this measurement taken on X-Ray?
We know that if a child with AIS enters adulthood with a curve over 30 degrees the chances of progression increase. This risk is heightened once the curve gets beyond 50 degrees. So, it’s understandable that Cobb angle plays a large part of the discussion when it comes to treatment goals. But with this focus it’s easy to lose sight of so many other important factors.
Medicine is an art and a science . We rely on scientific evidence to support our decisions but also have to make the best clinical decision possible when the evidence doesn’t ‘fit’ or is lacking. This is a very important thing to remember when we treat AIS. It is one of the reasons why a Consensus paper was published by SOSORT (The International Society of Scoliosis Orthopaedic and Rehabilitation Treatment in 2005 to answer the question ‘Why do we treat AIS’? (1).
The consensus paper published by the expert team of Negrini et al and members of SOSORT in 2005 (1) was able to clarify that there is more to treating a patient with AIS than simply being focused on Cobb angle.
Some of the reasons that were considered important, and indeed valid reasons to treat a patient with AIS include:
Since this consensus paper was published by SOSORT in 2005, more research has been published to support conservative therapy options for treatment of AIS. This includes research in regard to bracing and physiotherapeutic scoliosis specific exercises (PSSE) such as Schroth and the Scientific Exercise Approach to Scoliosis (SEAS) methods for scoliosis. Bracing now has stronger evidence thanks to the BrAIST trial by Weinstein et al (2). Schroth physiotherapy also now has stronger evidence supporting it thanks to research by multiple articles, including randomised controlled trials, providing higher level evidence for Schroth than we have had in the past (3-6).
Each patient I see has different goals for treatment outcomes. Some are heavily focused on Cobb angle while others are open to looking at other parts of the body. I focus on ‘treating the human, not just the spine’. Some people have a relatively small Cobb angle yet they have great asymmetry in regard to postural balance. In contrast, some patients have larger Cobb angles but more postural balance, particularly those with two balanced curves as opposed to one curve. Sometimes the first reason a parent will book an appointment is because the child has noticed pain, but that doesn’t happen all that often. Many adolescents with AIS don’t have pain.
It’s important for me as a physiotherapist to spend the time in my initial consultation finding out what the goals of the child and the parents are. In this way I find out if we are all on the same page when it comes to scoliosis treatment goals. Goals can change but if we get off to a good start from the beginning, all agreeing on some pre-determined goals, I find it easier to achieve patient compliance with the Schroth physiotherapy I prescribe, as well as compliance with wearing their brace if prescribed.